Coronavirus doctors diary: How the virus has changed our sleep patterns

Sleep disturbances are a common reaction to all natural disasters - from floods to epidemics, writes John Wright of Bradford Royal Infirmary, and the Covid pandemic is no exception.

 

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When I started this diary just over a year ago the virus was hurtling towards us from distant shores and my clinical colleagues were waking up in the middle of the night worrying about the brewing storm. When the hospital began filling with acutely ill patients, the insomnia stemmed from worries about individual patients and mental checklists for the day ahead.

As lockdown began, this insomnia spread rapidly to the rest of the population. In national surveys in the UK and Italy, the majority of people reported problems sleeping. The world was lying awake staring at the ceiling. Isolation and confinement from the lockdown, the breakdown of our normal routines, anxiety about catching the infection, and stress from job and economic insecurity all contribute to our nocturnal restlessness.

 

People with sleep problems before the pandemic have experienced a worsening of symptoms, and those who were good sleepers have started to experience insomnia. Sleep doctors have come up with the label of Covid-somnia or coronasomnia to describe the variety of sleep disorders, not just in patients but in the whole population. image captionSam Khan (left) has been suffering from long Covid - and waking up at 3am for the last few months
Many viral infections cause fatigue and drowsiness and Covid does too. This is a virus that clearly affects our nervous system - from our olfactory and facial nerves, causing loss of smell and taste, through to the long Covid legacy symptoms of headaches and brain fog. It is quite plausible that it has a long-lasting impact on our brain's sleep patterns.

 

I still have some minor long Covid symptoms: dysgeusia - strange tastes of metal and soap when I eat - and parosmia that alters my smell. I am perhaps a bit more forgetful, but this is difficult to disentangle from normal ageing and overwork. Most annoyingly, my sleep has become markedly disrupted - repeated awakenings with tossing and turning as I wait to drop off again.

Sam Khan, Bradford Royal Infirmary's clinical director of urgent care, has had it much worse. He got Covid on 24 March 2020, right at the start of the UK lockdown, and was then off work for five months with long Covid. He still feels breathless and tired, and still can't focus on things properly. He used to be good at analysing information and making rapid decisions, as doctors have to on a busy ward round, but now it's a challenge. Probably the majority of people we see, if they have any effect from the vaccine ,it seems to be a positive one

 

Dr Paul WhitakerBradford long Covid clinic
Interestingly, since Sam had the vaccine in December, his sleep has deteriorated - though there is no evidence of a causal link.

"At the end of the first week I suddenly realised I was waking up, bang, at 3am - and I'm a solid sleeper but that all changed. Now I go to bed at nine o'clock and wake up at 3am, and go to bed at 10 o'clock and wake up at 3am, and then I'd try going to bed at midnight, but would still wake up at 3am," he says.

Then it takes him an hour and a half to get back to sleep.

He's started taking anti-histamine, a mild sedative, before going to bed.image copyrightPishdaad Modaressi Chahardehi
Prof John Wright, a doctor and epidemiologist, is head of the Bradford Institute for Health Research, and a veteran of cholera, HIV and Ebola epidemics in sub-Saharan Africa. He is writing this diary for BBC News and recording from the hospital wards for BBC Radio.

Presentational grey line

Tina Mori, a matron in the newborn unit, says she used to feel fine on five or six hours' sleep a night, but Covid sent her sleep "all over the place". Recently, like Sam, she started sleeping even worse.

"Last night I had a really rough night, not sleeping and desperate to sleep," she says. "I'm sleeping for very short periods now and struggling to get back to sleep and it's like a continuous cycle."

 

Dr Paul Whitaker, who runs our long Covid clinic, says that patients with long-term symptoms may have difficulty sleeping - or on the other hand they may sleep excessively (up to 17 hours a day) because they are so tired. Or it can be a combination of both problems - they sleep during the day and therefore have problems sleeping at night. image copyrightJohn Wright image captionDr Paul Whitaker (right) with Dr Amira Valli
Sometimes mental health problems are a factor hindering sleep, or breathlessness, or - particularly in the case of people who were in intensive care - nightmares.

Paul's experience suggests that the vaccine sometimes brings an improvement in these symptoms - even if in Sam and Tina's case the opposite appeared to happen.

 

"Probably the majority of people we see, if they have any effect from the vaccine, it seems to be a positive one. A proportion of people do feel better after the vaccine - and that tends to be everything improving," he says.

In other cases the body appears to heal by itself, eventually.

"I was talking to a patient the other week who was quite young - these long Covid patients are hitting a year anniversary and it's been a year for her - and finally she's sleeping properly and the brain fog is lifting, so recovery does happen in time," Paul says.

Some readers of this diary may remember Mohammed Azeem, whose oxygen levels dropped more than once to a point his consultant described as "incompatible with life", and who spent 48 days in a coma in ICU. image copyrightJohn Wright image captionMohammed Azeem, before he was discharged
He says his whole pattern of sleep changed after Covid. He also began to be plagued by nightmares. He has seen a psychiatrist and been prescribed sleeping pills, but he is hoping that the end of lockdown will also help.

"Hopefully when lockdown is over I can start walking around more," he says. "Being outdoors more will help tire me,"

Sleep is such an important part of our physical and mental health. It is a time of recuperation when our body repairs itself and the mind processes the barrage of stimuli from the daytime.

Sleep also appears to be important for our immune systems, and a good night's sleep may help maximise our immune responses to vaccines. Everyone in England is to be given access to two rapid coronavirus tests a week from Friday, under an extension of the government's testing programme.

The lateral flow kits, which can provide results in around 30 minutes, will be available for free at testing sites, pharmacies and through the post.

The tests are already offered to school children and their families plus those who have to leave home for work.

The health secretary said the plan would help squash future outbreaks.

But critics of the programme say it risks becoming a "scandalous" waste of money.

It comes as Boris Johnson is due to meet the cabinet to sign off the next stage of lockdown easing in England, which will see non-essential shops reopen and pubs and restaurants start serving outdoors from 12 April.

Later, the prime minister will hold a Downing Street briefing, where he is expected to outline plans for coronavirus passports to enable mass-audience events to take place and confirm a traffic light system will be introduced when international leisure travel resumes.

Mr Johnson hailed the plan to offer everyone testing from 9 April, saying: "As we continue to make good progress on our vaccine programme and with our road map cautiously easing restrictions under way, regular rapid testing is even more important to make sure those efforts are not wasted." The rapid tests are aimed at those without any Covid symptoms and can be taken at home.

The government introduced lateral flow testing for secondary school children and staff earlier this year, under plans to reopen classes in England by March.

In February, the scheme was extended to the families of all school and college-age children in England.

Kits were also offered to those who cannot work from home in the pandemic, so they can be tested twice a week.

From 9 April, kits will be available through:

Community testing sites operated by local authorities
Collection from a nearby PCR test site during specific time windows
Existing workplace testing programmes
An online home ordering service with kits then delivered through the post
Participating local pharmacies where a box of 7 tests can be collected to be used twice a week at home
Anyone who tests positive using a lateral flow test will be expected to self-isolate along with their household. They can then order a second PCR Covid test, typically used for symptomatic cases, which will be sent off to a laboratory for analysis.

If the confirmatory test comes back negative, their quarantine period is considered over immediately and they can resume normal life.

media captionLaura Foster explains how to carry out a lateral flow test for Covid-19
The schools testing programme, combined with the wider use of workplace testing, has led to a jump in the number of lateral flow tests carried out in England.

There were about 250,000 rapid tests a day taken in mid-February - climbing to more than a million a day by the end of March.

Dr Susan Hopkins, Covid-19 strategic response director at Public Health England, said rapid testing might find cases that would not otherwise be discovered, helping to break chains of transmission and suppress the spread of variants or mutations of coronavirus. image copyrightReuters image captionSecondary school children in England have been using lateral flow tests since all classes restarted in March
Health Secretary Matt Hancock said: "Around one in three people who have Covid-19 show no symptoms, and as we reopen society and resume parts of life we have missed, regular rapid testing is going to be fundamental in helping us quickly spot positive cases and squash any outbreaks."

Shadow health secretary, Jonathan Ashworth, said any expansion of the testing scheme must be backed by financial support so people could self-isolate, adding: "Lack of adequate sick pay and support remains a dangerous hole in our defences against this horrific virus."

'False positives' concern

The latest data shows that, of the 4.2 million lateral flow tests taken in schools and colleges in the week from 18 to 24 March, 4,502 returned a positive result.

Critics of the programme say that when rates are at low levels, it makes it hard to distinguish between actual infections and so-called "false positives" - an error where the test registers a positive result incorrectly.

"Mass testing is a scandalous waste of money," said Allyson Pollock, professor of public health at Newcastle University.

"When the prevalence rate of coronavirus falls as low as it is at the moment then an increasing proportion of cases are likely to be false positives meaning that cases and contacts will self isolate unnecessarily."

Prof Pollock said it is likely that mass testing "is going to do more harm than good. We still haven't seen an evaluation of mass testing